ABG ( Allen’s Test)

Is an Allen’s test performed before or after an ABG needle stick?

BEFORE

21

Explain Allen’s Test Procedure

1. Explain 2. APPLY PRESSURE TO ULNAR AND RADIAL ARTERIES simultaneously 3. Ask the Pt to OPEN AND CLOSE HAND REPEATEDLY 4. PRESSURE RELEASED FROM ULNAR ARTERY WHILE COMPRESSING RADIAL ARTERY 5. COLOR OF EXTREMITY distal to the pressure point is checked 6. DOCUMENT

PALM SHOULD RETURN TO ITS NORMAL COLOR IMMEDIATELY PERSISTANCE OF PALLOR IN THE PALM AREA INDICATES OCCLUSION OF ULNAR ARTERY A+ Allen’s Test means that the pt DOES NOT HAVE DUAL BLOOD SUPPLY

What is a sputum analysis

IDENTIFIES CAUSE OF PULMONARY INFECTION AND ABNORMAL LUNG CELLS.

EXPECTORATION OR TRACHEAL SUCTIONING TO COLLECT SPECIMEN IS ACCEPTED

24

Explain Sputum Specimen procedure

- FLUID INTAKE ENCOURAGED NIGHT BEFORE - Instruct to RINSE MOUTH WITH WATER BEFORE SPECIMEN COLLECTION - DO NOT BRUSH TEETH, EAT, or USE MOUTHWASH BEFORE TEST - STERILE CONTAINER USED - Ultrasonic/heated nebulizer treatment 10-15 min prior aids in collection - Teach Pt. how to expectorate - Collect SPECIMEN EARLY MORNING/BEFORE EATING AND DRINKING-Specimen should be representative of pulmonary secretions and NOT SALIVA - NOTE ANY CURRENT ANTIBIOTIC THERAPY ON LAB SLIP - SPUTUM COLLECTED MUST BE AT LEAST 5 ML - Culture requires at least (48 HRS FOR COMPLETION)- Sputum culture for fungus and mycobacterium may take 6-8 weeks - Tell the Pt. to notify the nurse as soon as the specimen is collected

Lung Biopsy. Explain procedure.

LUNG TISSUE REMOVAL FOR CULTURE OR CYTOLOGY

Post: 1. Monitor VS and breath sounds every 4 hrs for 24 hrs 2. STERILE DRESSING on biopsy site MONITOR FOR DRAINAGE OR BLEEDING 3. MONITOR SIGNS OF RESPIRATORY DISTRESS 4. Chest X-Ray take after the procedure to check for complications of pneumothorax

MONITOR for AIR EMBOLI and PNEUMOTHORAX, NOTIFY RN AND HCP IF THEY OCCUR

What are the causes of LOW PRESSURE ALARM in ventilators ?

Mechanical Vent Intervention

1. Check VS LUNG SOUNDS RESPIRATORY STATUS BREATHING PATTERNS 2. Skin color (NAIL BEDS/LIPS)3. Chest for bilateral expansion 4. TAKE PULSE OX5. ABG levels6. IF THERE IS NEED FOR SUCTIONING and observe TYPE/COLOR AND AMOUNT OF SECRETIONS 7. Check vent settings 8.Check the level of the humidifier and the temperature of the humidification system, high temps can damage the mucosa in the airway 9. Ensure alarm is set10. If cause for alarm can not be determined ventilate the client manually with a resuscitation bag until the problem is correct11. Empty the ventilator tubing when moisture collects 12. Turn every 2 hours or get the client out of bed to prevent complications with immobility 13. Resuscitation equipment ready at bedside

36

Peak Flow Meter

Device to measure airflow through the bronchi and degree of obstruction in the airways. Main asthmatic patients

Interpreting Peak (Yellow Zone)

Interpreting Peak ( Red Zone )

- (Less than 50% of personal best )- SIGNALS A MEDICAL ALERT - IMMEDIATE DECISIONS AND ACTIONS - SEVERE NARROWING of airway may be occurring - Administer a short acting bronchodilator - Notify MD IMMEDIATELY if it does not return immediately and STAY in YELLOW or GREEN ZONES

41

Incentive Spirometer

- Device for MEASURING LUNG CAPACITY - KEEPS LUNGS CLEAR

42

Purposes for Incentive Spirometer

1. HELP IMPROVE LUNG FUNCTION 2. PTs who had any surgery that may significantly affect the respiratory function 3. Pts on extended use of anesthesia 4. Pts with rib injury to help minimize fluid build-up in the lungs

43

Patient teaching for Incentive Spirometer

1. Have the patient assume a comfortable position ( SEMI-FOWLER or SITTING) in chair or bedside 2. Demonstrate how to place mouthpiece so that lips completely cover mouthpiece 3. Instruct to inhale slowly and maintain constant flow through the unit. Hold breathe for (1-2 seconds) exhale slowly 4. Instruct client to breathe normally for short period time 5. Hold the incentive spirometer in an upright position. Place the mouthpiece mouthpiece in your mouth and seal lips tightly around it. Breathe in slowly and as deeply as possible, raising the yellow ball toward the top of the column. The yellow coach indicator should be in the blue outlined area